{"entity":{"id":"idea-acc-default-fertility-preservation-referral","kind":"idea","name":"Default fertility preservation referral for every patient under 40 before treatment","aka":[],"tldr":"Fewer than half of patients starting treatment that can damage fertility have a documented fertility discussion or referral, with worse rates for women, minorities and patients outside academic centres. An order-set trigger that refers every patient under 40 to reproductive medicine unless they actively decline would make the conversation routine and timely.","summary":"Guidelines require discussion of fertility preservation before gonadotoxic therapy, yet documented discussion and referral rates remain well below half in published series, with worse rates for women, minorities, and patients at non-academic centres. An order-set trigger that creates a fertility referral for every patient under 40 unless actively declined, with a fast-track reproductive medicine pathway and funding for preservation, would close this gap.","asOf":"2026-09-08","links":[{"label":"Oktay et al., Fertility Preservation in Patients With Cancer: ASCO Clinical Practice Guideline Update (J Clin Oncol 2018)","url":"https://doi.org/10.1200/JCO.2018.78.1914"},{"label":"Algave et al., Fertility preservation access among female adolescents and young adults with cancer: a systematic review (Cancer 2026)","url":"https://doi.org/10.1002/cncr.70486"},{"label":"Bottleneck evidence (Survivorship and late effects are neglected): NCI Office of Cancer Survivorship statistics","url":"https://cancercontrol.cancer.gov/ocs/statistics"},{"label":"Bottleneck evidence (Toxicity and quality of life are undervalued): Di Maio et al., Symptomatic toxicities experienced during anticancer treatment: agreement between patient and physician reporting (JCO 2015)","url":"https://doi.org/10.1200/JCO.2014.57.9334"}],"tags":["protocol-upgrade","upgrade:proven-unevenly-used","evidence:moderate"],"related":[],"cancers":["hodgkin-lymphoma","tnbc","all-leukemia"],"sections":["supportive-care","rejuvenation"],"technologies":["fertility-preservation","rejuv-access-fertility-preservation"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-survivorship","b-care-fragmentation","b-toxicity-qol"],"keyPapers":["paper-oktay-j-clin-oncol","paper-di-maio-j-clin-oncol"],"journals":[],"dependsOn":[],"notes":["Protocol upgrade, graded proven but unevenly used on guideline-level evidence. ASCO's 2018 guideline asks clinicians to discuss the possibility of infertility as early as possible with patients treated in their reproductive years, to be prepared to refer all potential patients to reproductive specialists, and to document the discussion; sperm, oocyte and embryo cryopreservation are standard practice.","Adoption gap, as measured: a systematic review of 25 United States studies of female adolescents and young adults found fertility preservation discussions ranging from 9 to 75 per cent, referrals from 0.9 to 57 per cent and completed procedures from 0.56 to 70.3 per cent; institutional interventions improved access but did not remove the disparities by race, income, insurance and rurality (Algave, 2026)."],"hypothesis":"Default referral will raise documented fertility counselling to above 90% of eligible patients and double the proportion undergoing preservation, without delaying treatment start by more than a week.","rationale":"Defaults outperform reminders; the time-critical nature of preservation means that a missed conversation is irreversible.","test":"Run a stepped-wedge implementation across ten centres with counselling documentation, preservation uptake, treatment delay, and regret at two years.","maturity":"being-tested-at-scale","actor":"clinic","cost":"small","horizonYears":2},"route":"/ideas/idea-acc-default-fertility-preservation-referral/","neighbours":{"cancer":[{"id":"all-leukemia","kind":"cancer","name":"Acute lymphoblastic leukaemia","route":"/cancers/all-leukemia/"},{"id":"aya-cancers","kind":"cancer","name":"Adolescent and young adult cancers (ages 15 to 39)","route":"/cancers/aya-cancers/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"}],"section":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"rejuv-paed-fertility-male","kind":"technology","name":"Fertility in boys and young men treated for cancer, including testicular tissue banking","route":"/technologies/rejuv-paed-fertility-male/"},{"id":"rejuv-paed-fertility-female","kind":"technology","name":"Fertility in girls and young women treated for cancer, including ovarian tissue freezing","route":"/technologies/rejuv-paed-fertility-female/"},{"id":"fertility-preservation","kind":"technology","name":"Oncofertility and fertility preservation","route":"/technologies/fertility-preservation/"},{"id":"ovarian-function-after-chemotherapy","kind":"technology","name":"Ovarian function after chemotherapy: who recovers, and when","route":"/technologies/ovarian-function-after-chemotherapy/"},{"id":"rejuv-access-fertility-preservation","kind":"technology","name":"Who gets told about fertility before treatment, and who does not","route":"/technologies/rejuv-access-fertility-preservation/"}],"bottleneck":[{"id":"b-care-fragmentation","kind":"bottleneck","name":"Fragmented care and guideline gaps","route":"/bottlenecks/b-care-fragmentation/"},{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}],"paper":[{"id":"paper-oktay-j-clin-oncol","kind":"paper","name":"Fertility Preservation in Patients With Cancer: ASCO Clinical Practice Guideline Update","route":"/key-papers/paper-oktay-j-clin-oncol/"},{"id":"paper-di-maio-j-clin-oncol","kind":"paper","name":"Symptomatic toxicities experienced during anticancer treatment: agreement between patient and physician reporting in three randomized trials","route":"/key-papers/paper-di-maio-j-clin-oncol/"}],"roadmap":[{"id":"survivorship-roadmap","kind":"roadmap","name":"Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards","route":"/roadmaps/survivorship-roadmap/"}]}}